Background to this inspection
Updated
1 February 2018
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.
This was an announced focused inspection carried out on 7, 8 and 19 December 2017. We gave the service 48 hours’ notice of the inspection visit because it is small and the manager is often out of the office supporting staff or providing care. We needed to be sure they would be in.
Inspection site visit activity started on 7 December 2017 and ended on19 December 2017. We visited the office location on 7 December 2017 to see the manager and to review care records, policies and procedures. We looked at six people’s care plans and medicines records. We made telephone calls to staff on19 December 2017.
The inspection was carried out by one adult social care inspector, a pharmacist specialist inspector and an expert-by-experience who had experience of domiciliary care services. An expert-by-experience is a person who has personal experience of using or caring for someone who uses this type of care service. The expert by experience made telephone calls to people who used the service and their relatives on 8 December 2017.
Before our inspection, we reviewed all the information we held about the service, including previous inspection reports and statutory notifications sent to us by the service. Statutory notifications contain information about changes, events or incidents that the provider is legally required to send us. We contacted the local authority, other stakeholders and Healthwatch. Healthwatch is an independent consumer champion that gathers and represents the views of the public about health and social care services in England.
Before the inspection providers are asked to complete a Provider Information Return (PIR). This is a form that asks the provider to give some key information about the service, what the service does well and improvements they plan to make. We did not ask the service to provide us with a PIR prior to this inspection.
At the time of the inspection, there were 14 people receiving the regulated activity of personal care from the provider. During our inspection, we spoke with five people who used the service, one relative, three care staff, the manager and two managers from other services managed by the provider.
Updated
1 February 2018
This was an announced focused inspection carried out on 7, 8 and 19 December 2017. This inspection was done to check that improvements to meet legal requirements planned by the provider after our comprehensive inspection of 18 May 2017 had been made. The team inspected the service against two of the five questions we ask about services: is the service safe and is the service well- led. This is because the service was not meeting some legal requirements.
No risks, concerns or significant improvement were identified in the remaining Key Questions through our on-going monitoring or during our inspection activity so we did not inspect them. The ratings from the previous comprehensive inspection for these Key Questions were included in calculating the overall rating in this inspection.
We carried out an unannounced comprehensive inspection of this service on 18 May 2017. At that inspection we found the provider had breached two regulations associated with the Health and Social Care Act 2008. Medicines were not managed safely and our concerns regarding the management of people’s medicines had not been identified through the audits in place. We therefore concluded the audits on medication were not effective. At this inspection we found continuing concerns with the safe management of medicines and governance arrangements were still not robust enough.
This service is a domiciliary care agency. It provides personal care to people living in their own houses and flats. It provides a service to older adults and younger disabled adults.
At the time of the inspection, the service had a manager registered with the Care Quality Commission (CQC); however, they had left the service a few weeks previously. A new manager had been appointed and told us they would be making their application to become the registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act and associated Regulations about how the service is run.
We found the provider was failing to protect people using the service against the risks associated with the unsafe use and management of medicines. Clear and accurate records were not being kept of medicines administered by staff. Gaps in the medicines administration records meant we could not be sure people were always given their prescribed medicines. Care plans and risk assessments did not support the safe handling of people’s medicines.
Systems to monitor quality and identify issues and areas for improvement at the service were not always effective or recorded well. This did not demonstrate a commitment to continuous improvement of the service.
Staff understood their role and responsibilities for maintaining good standards of cleanliness and hygiene. However, people who used the service said staff did not always wear full personal protective equipment. We informed the manager of this and action was taken to address the concern.
People who used the service and their relatives were complimentary of the staff and manager. People told us they felt safe using the service and they had consistent staff who knew their needs and provided good care.
Staff had completed safeguarding training and knew the signs of abuse to look out for and how to raise any concerns. There were enough staff to deliver care safely, and staff were recruited in a safe way.
Staff spoke positively of the management team. They told us there was a positive working culture and they were given the support they needed to carry out their roles.
You can see what action we told the provider to take at the back of the full version of the report.